Exploring the relationship between menstrual cycle and urticaria: Insights from a cross-sectional study

Chronic spontaneous urticaria (CSU) is characterized by recurrent wheals lasting over 6 weeks, with various internal and external triggers implicated. Autoimmune progesterone dermatitis, a rare condition associated with cyclical urticaria in response to elevated progesterone levels, may overlap with CSU, particularly in women with menstrual cycle-related exacerbations.

To document and analyze the timing of urticaria episodes in relation to the menstrual cycle to better understand this phenomenon.

This cross-sectional study was conducted at Omdurman Maternity Hospital and Omdurman Friendship Hospital in Sudan from January to June 2022. We included 75 women (ages 18-45) with CSU suspected to be linked to their menstrual cycle. Participants completed a structured questionnaire detailing demographic information, menstrual history, urticaria episodes, and associated symptoms.

Among the 75 participants, 46.7% experienced urticaria exacerbation coinciding with menstruation, primarily within the first 3 days. Another 33.3% reported premenstrual urticaria, while 20% had postmenstrual symptoms. The majority exhibited classic urticarial wheals, with only 3.7% experiencing angioedema. Premenstrual urticaria was significantly associated with the 21 to 30 age group (P = 0.030). A majority had a history of allergic conditions, suggesting a predisposition to urticaria influenced by hormonal fluctuations.

This study highlights a significant association between the menstrual cycle and urticaria, suggesting that hormonal fluctuations play a key role in symptom exacerbation. These findings provide a basis for future research into the underlying mechanisms of hormonally influenced urticaria and the development of targeted therapeutic strategies, such as hormonal modulation or individualized treatment plans for affected patients.